Prevalence, Management and Outcomes of Enterocutaneous Fistulas in Buea Regional Hospital and Laquintinie Hospital of Douala. A Five Years Retrospective Study

Background: An Enterocutaneous fistula (ECF) is an abnormal connection between the intestinal tracts or stomach and the skin. They are a major catastrophe to the patient and surgeons and still have a high incidence of morbidity and mortality which varies between 6% - 33%;their management remains a big challenge. These patients frequently face complications, and a well-organized multidisciplinary approach must be implemented in their management to improve outcomes. Objectives: Our study aims to assess the prevalence, management and outcomes of enterocutaneous fistulas in Buea regional hospital and Laquintinie hospital of Douala over the past 5 years. Methods: This was a hospital-based retrospective study in Buea regional hospital and Laquintinie hospital of Douala. Records of patients who had enterocutaneous fistulas within the period of 1st January 2017 to 31st December 2020 in the surgical departments. Data included demographics, pre-operative diagnosis, comorbidities, type of fistula, management modality and means, the indication of operative treatment, length of stay in the hospital and outcomes. Data was analysed using SPSSv26. Results: The study constituted 1343 medical records of which 83 medical records of patients with enterocutaneous fistulas, giving a prevalence of 6.2%, female predominance at 59% (n = 49), 42.2% (n = 35) were referred cases from the periphery for better management. A vast majority (96.4%) occurred as post-operative complications with appendectomy the most common indication (18.8%). High output fistulas were predominant (43.4%). 59% (n = 47) were managed medically, 6% (n = 5) received both conservative and surgical modalities while 35% (n = 5) were managed surgically. 64.1% (n = 50) were placed on enteral nutrition while 35.9% (n = 28) were placed on parenteral nutrition. Peritonitis/infection 50% (n = 18) was the commonest indication of surgical treatment, followed by failure of medical treatment 25% (n = 9) then high output fistulas 16.7% (n = 6). Resection with end-to-end anastomosis was the preferred repaired work at 61% (n = 22). The mortality rate was 38.5% (n = 32), 29% (n = 24) healed after conservative treatment, 21.7% (n = 18) healed after surgery, 7.2% (n = 6) persisted after surgery while 3.6% (n = 3) persisted after conservative treatment. Anaemia, sepsis, electrolyte imbalance, dehydration and malnutrition were the commonest complications. Conclusion: The prevalence of enterocutaneous fistulas was high, with a female predominance and a mean age of 38 years. Most cases were seen as a referral from the periphery for better management. The greatest majority of fistulas occurred as a postoperative complications. Conservative management with enteral feedings was preferred, they had better outcomes and gave more chances of healing. The commonest indication of surgical treatment was an infection. Resection with end-to-end anastomosis was the preferred repaired work. The mortality rate was high, and anaemia, sepsis and electrolyte imbalance were the commonest complications.

Etiologies, Clinical Presentation and Outcome of Adult Patients Presenting with Bowel Obstruction on a Virgin Abdomen

Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of intestinal obstruction on a virgin abdomen or unhealed abdomen at the central hospital of Yaoundé in order to better understand the main causes and to better anticipate and improve the diagnosis, management and the evolution of intestinal obstruction on a virgin abdomen. Method: The patients were prospectively included from June 2021 to May 2022, these patients were recruited from the digestive and emergency surgery units of the Yaoundé Central Hospital during the study period and who met the inclusion criteria, with suspicion of partial or total intestinal obstruction or those with an intraoperative confirmed diagnosis were enrolled. Results: We recruited 73 patients including 43 (60.3%) men and 29 (39.7%) women whose mean age was 42.5 years with extremes ranging from 16 to 70 years. Most of them consulted after 72 hours, i.e. 65.2% of cases due to self-medication or even prior consultations in the lower level center at the Central Hospital of Yaoundé. The patients retained for this work presented in majority the symptoms according to the abdominal pains, the stop of the materials and gases;meteorism and vomiting. Abdominal wall hernias with incarcerated intestinal loops were the most common cause of intestinal obstruction in an unscarred abdomen in adults at 38.4% of cases, followed by digestive tumors 23.3% and adhesions 17.8%. Exceptionally, a cluster of roundworms was found as the cause of intestinal obstruction in two of our patients. Complications occurred in 25 patients or 31.5% of cases and were dominated respectively by nausea and hematoma (36%), local infections (24%) and malaria (24%). Death occurred in 5 of our patients, or 6.8% of cases, and was mostly caused by hypovolemic shock (40%) and pulmonary embolism (40%). Conclusion: Intestinal obstructions on the abdomen without scarring remain the prerogative of young adults and are caused by strangulated hernias with incarcerated intestinal loops, tumors and adhesions. The rate of complications remains high and they are dominated by infectious pathology. Their mortality is clearly improving.

Prevalence, Aetiology, and Clinical Profile of Acute Abdomen in Pregnancy in Southwest Cameroon: A 5-Year Retrospective Study

Background: Acute abdomen is one of the commonest reasons for presentation at the emergency department. The physiologic changes of pregnancy increase the chances of developing acute abdomen. The global incidence of acute abdomen in pregnancy range from 1 in 500 to 1 in 635 pregnant women. In 2018, a study in Azerbaijan reported a prevalence of 25%. However, to the best of our knowledge, very few studies have been carried out on this subject in Cameroon. Objectives: To determine the prevalence, assess the aetiologies, and review clinical profile of acute abdomen in pregnancy in the Southwest Cameroon. Methods: We conducted a 5-year retrospective study at the Obst/Gyn and Surgical units of Kumba, Buea, and Limbe Regional Hospitals. We included all files of pregnant women that were admitted for acute abdomen within the study period (1st Jan 2017 to 31st Dec 2021). Data was collected using a structured checklist adapted from previous studies. Descriptive statistics and statistical testing was done using SPSS version 25.0. Chi-square was used to compare categorical variables. p Results: Over 14,106 pregnant women were admitted to the aforementioned hospitals within the study period. 335 (2.4%) met our inclusion criteria. The patients’ age ranged from 17 to 43 years. The mean age was 27 years. Acute abdomen was more frequent (65%) in the first trimester. Ectopic pregnancy was the commonest obstetric aetiology while appendicitis was the commonest non obstetric surgical aetiology. Abdominal pain and tenderness were the most common presentation. Conclusion: The prevalence of acute abdomen in pregnancy in the Southwest Cameroon is 10 times higher than the global prevalence. Our study also confirmed the numerous aetiologies and varied clinical presentations of acute abdomen in pregnancy. Hence a wake-up call for primary care physicians.

Internal Lateral Sphincterotomy in Yaounde: Comparative Short-Term Results of Open versus Closed Techniques

Background: Chronic anal fissure is a benign disorder which is associated with considerable discomfort. Aim of the Work: The aim of this study was to compare the post-operative results of open and closed internal lateral sphincterotomies in the short and medium term. Patient and Methods: We carried out a prospective randomized comparative study in the digestive and visceral surgery departments of Central Hospital of Yaounde over a period of 15 months. Patients were evaluated for each technique by several variables, including duration of surgery, post-operative pain, recurrence, surgical wound infection, gas and/or stool incontinence, and healing time with follow-up up to 12 months postoperatively. Results: A total of 63 patients underwent surgery within them we had 32 open lateral internal sphincterotomies (group 1) and 31 closed lateral internal sphincterotomies (group 2). There were 35 men and 28 women with a sex ratio of 1.25. The mean age was 35.36 ± 10.16 years with extremes ranging from 19 to 62 years. The typical presentation was pain on defecation. The majority of fissures were located at the posterior commissure. The average duration of the procedure was longer in patients in group 1 (15.34 minutes) compared to 5.22 minutes in patients in group 2. We found 3.12% of surgical wound infections in patients in group 1 and neither patient in group 2. Gas incontinence was 6.45% in group 2 patients and 28.12% in group 1. The mean intensity of pain at 24 hours post-operative was between 4 and 6 on the visual analogue scale in patients in group 2 and between 7 and 10 in group 1. Wound healing time was 8.9 days in group 1 and 4 days in group 2 patients. The hospital stay was 24 hours for both groups of patients. No recurrence was noted during the 6-month follow-up period. Conclusion: Closed lateral internal anal sphincterotomy is the treatment of choice for chronic anal fissures because it is effective and associated with a lower complication rate than the open sphincterotomy technique.

Survival and Quality of Life of Patients after Rectal Cancer Surgery in a Low-Income Country: A Study in Cameroon, Sub-Saharan African Region

Background: Survival of patients after rectal cancer surgery as well as their quality of life (QoL) has been little studied in Africa and never in our country in particular. Methods: We conducted a cross-sectional multicentre study in Yaoundé (Cameroon). We reviewed operating reports of the selected departments to identify patients operated from January 2010 to December 2019 for a rectal cancer. The outcome of patients enrolled had to be known until December 2020. Patients who were alive were contacted to evaluate their QoL using the EORTC QLQ C30 (European Organization for Research and Treatment of Cancer QoL questionnaire). Results: During the study period, rectal cancer was ranked 4th within the digestive cancers. We included 68 patients;their mean age was 49.74 years and 41.18% were under 45. The sex ratio was 1.19 in favour of males. The tumour was mainly located in the lower rectum (45.6%). The main surgical procedure implemented was abdomino-perineal resection (42.6%). Forty-one patients died, giving a mortality rate of 60.29%. The mean survival time was 13 months. The 5-year survival rate for the 32 patients operated from January 2010 to December 2015 was 21.87%. The overall QoL of the 27 living patients was good with a mean of 62.346 ± 15.907. Sexual complications and urinary disorders were found in 40.74% and 14.81% of patients, respectively. Conclusion: There is a low hospital incidence of rectal cancer in our context. The 5-year survival after rectal cancer surgery is poor while the QoL of living patients is good.

Outcomes and Quality of Life of Patients with a Digestive Stoma in Sub-Saharan Africa: Case of the Yaounde Central Hospital, Cameroon

Introduction: The installation of a digestive stoma involves changes affecting all aspects of the patients’ lives. The objective of this study was to determine the impact of a digestive stoma on the quality of life of patients operated on at the Yaounde Central Hospital (YCH). Patients and Methodology: We conducted a prospective descriptive study over a period of 12 months from June 2018 to May 2019 in all patients with a digestive stoma for at least 3 months operated on at the YCH. The follow-up was done within 12 months. Quality of life was assessed using the stoma QOL (quality of life) and self-image using the BIS (Body Image Scale). Results: We collected a total of 34 patients, of whom 22 were male, giving an M/F sex ratio of 1.8. The average age of the patients was 42.8 years. The indications were tumoral in 44.11% of cases (n = 15) and non-tumoral in 55.88% of cases (n = 19). The colon was the most frequently ablated organ (n = 26) with 76.5% of colostomies. The complication rate was 67.6%. Stomal oedema was the most common early complication with 38.2% of cases. All patients used colostomy bags. The average time to return to sexual activity was 8 months for men and 9 months for women. 85.3% of the patients had an average impairment of quality of life according to the Stoma Quality of Life Scale. According to the Body Image Scale, 73.5% of the patients had a moderate dissatisfaction with their self-image. Conclusion: The realization of a digestive stoma imposes a long-term follow-up especially on the psychological level in order to allow the empowerment of the patients who all have a modification of their quality of life and their self-image.